Association of basal serum testosterone levels with ovarian response and in vitro fertilization outcome

Abstract

BackgroundTo evaluate basal testosterone (T) levels during follicular phase of the menstrual cycle as a predictor for ovarian response and in vitro fertilization (IVF) outcome.MethodWe analyzed data retrospectively from hospital-based IVF center including one thousand two hundred and sixty Chinese Han women under their first IVF cycle reached the ovum pick-up stage, without polycystic ovary syndrome (PCOS) or endometriosis undergoing long IVF protocol. Patients were divided into 2 groups. Group 1: patients with diminished ovarian reserve (basal FSH >10 IU/L) (n = 187); Group 2: patients with normal ovarian reserve (basal FSH < = 10 IU/L) (n = 1073). We studied the association of basal T levels with ovarian response and IVF outcome in the two groups. Long luteal down-regulation protocol was used in all patients, that is, the gonadotropin releasing hormone agonist was administered in the midluteal phase of the previous cycle and use of recombinant FSH was started when satisfactory pituitary desensitization was achieved.ResultsBasal T levels were markly different between pregnant and non-pregnant women in Group 1; whereas not in Group 2. A testosterone level of 47.85 ng/dl was shown to predict pregnancy outcome with a sensitivity of 52.8% and specificity of 65.3%; and the basal T was correlated with the numbers of large follicles (> 14 mm) on HCG day in Group 1. Significantly negative correlations were observed between basal T, days of stimulation and total dose of gonadotropins after adjusting for confounding factors in both groups.ConclusionIn women with diminished ovarian reserve, basal T level was a predictor for the number of large follicles on HCG day and pregnancy outcome; but could not in those with normal serum FSH. Basal T levels were associated with both days of stimulation and total dose of gonadotropins, indicating that lower level of T might relate with potential ovarian poor response.

Low testosterone levels in women with diminished ovarian reserve impair embryo implantation rate: a retrospective case-control study

“…The medical records of 1598 Chinese women undergoing their first IVF-ET cycle and reaching the oocyte pick-up stage at Reproductive Medical Center, People's Hospital, Peking University, between March 2009 and December 2010 were reviewed. DOR was defined as a basal FSH value >10 IU/L or an FSH : LH ratio >3 [1,7]. Women with DOR were recruited.…”

“…Clinical pregnancy was confirmed by positive fetal cardiac activity and by the number of sacs counted using vaginal ultrasound at a gestation of 6 weeks. High-quality embryos were defined as embryos developed from normal fertilized eggs with no fragmentation or no more than 1/3 fragmentation, no presence of multinucleation, and 7-8 blastomeres 72 h after egg retrieval [7].…”

“…Shortly thereafter, however, researchers from the same group rejected this predictive value of pregnancy outcome [6]. A recent study showed that basal T levels could predict the number of large follicles on the HCG day and pregnancy outcome in women with DOR but not in women with normal ovarian reserve [7]. Thus, whether serum basal T levels can influence IVF ovarian response and predict outcomes in women with DOR requires further study.…”

Role of decreased androgens in the ovarian response to stimulation in older women

“…Serum testosterone (T) decreases as age advances in premenopausal women (1)(2)(3)(4), paralleling a similar age-related decline of antral follicle count (AFC) and level of antim€ ullerian hormone (AMH). Because it has been found that the T response to human chorionic gonadotropin (hCG) decreases with age (5), it is assumed that there is an age-related decrease of T secretion from the theca tissue surrounding ovarian follicles.…”

Basal serum testosterone levels correlate with ovarian response but do not predict pregnancy outcome in non-PCOS women undergoing IVF

“…To the best of our knowledge, the application of basal serum T levels for predicting ovarian response and pregnancy outcome is debated. Yingying Qin's group suggested that basal T level was a predictor for ovarian response and pregnancy outcome in women with diminished ovarian reserve; but could not in those with normal serum FSH [8]. However, Fratharelli and Peterson's study showed that patients with Day 3 testosterone level lesser than 20 ng/dl were five time less likely to achieve pregnancy [9].…”